From the Guidelines
Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that cause abnormal postures or repetitive movements, affecting various parts of the body, including the neck, eyes, vocal cords, hands, or the entire body, and can be primary or secondary, resulting from genetic, idiopathic, or external factors such as injury, stroke, or medication side effects. The condition occurs when the brain sends incorrect signals to muscles, causing them to contract inappropriately. According to the most recent evidence 1, dystonia can be managed with various treatment strategies, including oral medications, botulinum toxin injections, and physical therapy.
Treatment Options
- Oral medications such as anticholinergics (trihexyphenidyl), muscle relaxants (baclofen), or benzodiazepines (diazepam) can help manage symptoms.
- Botulinum toxin injections directly into affected muscles are often the most effective treatment, particularly for focal dystonias, with effects lasting 3-6 months before requiring repeat injections, as supported by the study 1.
- Physical therapy and stress management techniques can also help manage symptoms, with strategies such as encouraging optimal postural alignment, grading activity to increase the time that the affected limb is used, and avoiding postures that promote prolonged positioning of joints at the end of range 1.
Quality of Life
While dystonia is typically not life-threatening, it can significantly impact quality of life and often requires ongoing management with a neurologist specializing in movement disorders. The condition can cause significant distress and discomfort, and effective management is crucial to improving the patient's quality of life. As noted in the study 1, dystonias are often quite distressing and, in the case of laryngospasm, can be life-threatening, highlighting the importance of prompt and effective treatment.
Management
In severe cases unresponsive to other treatments, deep brain stimulation surgery may be considered. It is essential to work with a neurologist specializing in movement disorders to develop a personalized treatment plan and manage symptoms effectively. By prioritizing the most recent and highest-quality evidence, healthcare providers can provide optimal care and improve patient outcomes, as emphasized by the study 1.
From the Research
Definition of Dystonia
- Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions 2.
- It is defined as a neurological syndrome characterized by involuntary, patterned, sustained, or repetitive muscle contractions of opposing muscles, causing twisting movements and abnormal postures 3.
- Dystonia is a movement disorder characterized by involuntary muscular contractions that generate twisting and repetitive movements and/or abnormal postures 4.
Types of Dystonia
- Dystonia can be classified as isolated dystonia (either idiopathic or genetic) or combined dystonia (with additional signs) 2.
- It can affect a few muscle groups (focal dystonia) or spread to most muscles in the body (generalized dystonia) 4.
- Primary dystonia is a type of dystonia without a specific cause, while secondary dystonia has a known cause, such as gene mutations or other underlying conditions 3.
Diagnosis and Treatment
- The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge 2.
- Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection, and deep brain stimulation are available 2, 3.
- Deep brain stimulation is becoming the standard of care for medically intractable, disabling dystonias, with advantages including reversibility, adjustability, and continued access to the therapeutic target 4.